Monday, March 30, 2009

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily.

Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person.

New York state implemented such a law in 1999. Five years later, a report showed that individuals in the program experienced 77 percent fewer psychiatric hospitalizations, 87 percent fewer incidents of incarceration, and 74 percent less homelessness.

Greenleaf said he's mindful of Pennsylvania's history with the mentally ill, in which too many people were institutionalized and forgotten. "We're not going back to the bad old days," he said.

Rather, mental-health advocates say, the problem now is that too many people don't receive treatment before coming into contact with the criminal-justice system. About 20 percent of prison inmates suffer from mental-health issues. Those who do end up in prison tend to stay in prison longer than other inmates, costing the state more money and denying themselves effective treatment.

Supporters estimate that court-ordered outpatient treatment would benefit about 500 people in Pennsylvania annually. They say the service network is already in place to help such people in most counties.

Greenleaf said the legislation would not cost the state more money because Medicaid pays for these services. That aspect needs to be explored more thoroughly. While the state could very well save money with fewer prisoners and fewer state hospital commitments, some county human-service agencies might face greater demand for their services.

The state Senate should move ahead with this legislation, the goal of which is more effective patient care, fewer hospitalizations, and fewer incarcerations.

Sunday, March 29, 2009

Responding to the growing problem of mentally ill Floridians ending up in jails and prisons, lawmakers are moving forward on a sweeping initiative that will help better identify and treat those residents. Proponents call it one of the most significant rewrites of the state mental health law since the Baker Act was passed in 1971, reforming the way the mentally ill are committed for treatment.

Although the program is ambitious, it will start off on a small scale, with three pilot projects and will not require new state funding.

But advocates say it has the potential to save the state billions of dollars in the long term by improving the treatment of the mentally ill and keeping them out of costly prison beds or forensic treatment centers.

"This bill will without a doubt ensure a more fair treatment of people with mental illness. It will not only add fairness but effectiveness to the system," said Rep. Yolly Roberson, D-Miami, as the proposal was endorsed by the House Criminal and Civil Justice Policy Council on Tuesday. "It's a win-win for all parties."

Miami-Dade Judge Steven Leifman, who has spearheaded the legislation as a special adviser to the state Supreme Court on criminal justice and mental health, said the proposal is designed to bring the state's handling of mentally ill citizens in line with new treatment systems that can help those residents avoid ending up in jails or prisons.

"We've pushed a lot of people into the criminal justice system that don't need to be there," Leifman said.

A 2007 report to the Supreme Court found on a daily basis there were about 70,000 Floridians with a serious mental illness who were in prisons or jails, or under some type of correctional supervision. The report said that annually more than 125,000 Floridians with mental illnesses were being booked into county jails.

"The vast majority of these individuals are charged with minor misdemeanor and low-level felony offenses that are a direct result of their psychiatric illnesses," the report found.

Leifman said the mentally ill prisoners were the fastest growing segment in the state prison system, saying a projection shows it could cost the state more than $3 billion over the next decade to build new prison space and maintain those beds for that population. The other escalating demand is being put on the state's forensic facilities -- where persons charged with a felony but deemed mentally incompetent are sent until they have recovered enough to stand trial.

Florida is now spending roughly $250 million a year on 1,700 forensic beds, which gives it the distinction of running one of the most costly systems in the country. At the same time, the state has been criticized by national mental health groups for being near the bottom when it comes to spending on mental health programs outside of the criminal justice system.

"We've deep-ended our system so poorly that there aren't enough resources to provide the level of services that we now know are required to keep people out of the criminal justice system," Leifman said.

The new bill aims to target people who can be diverted from the criminal justice system, while also providing better treatment for the approximately 6,000 inmates with serious mental illnesses who are released from prison each year.

About half of those inmates end up going back to prison, Leifman said. The measure has the support of key state agencies including the Department of Children and Families, the Department of Corrections and the Agency for Health Care Administration.

DCF Secretary George Sheldon, who oversees the forensic treatment centers, said the current system does not make sense in that many felons who are sent to the centers spend enough time there in recovery only to be released back into the community for "time served" once they are deemed competent to stand trial.

Under the proposal, state officials hope to use some of the money now slated for the forensic beds for the upfront treatment initiatives, thus saving the state money in the long run. "It's a much more sensible use of money," Sheldon said. "What we're doing right now is the true definition of insanity."

Leifman said another advantage of the plan is that the federal government will pay a majority of the program's costs -- through the Medicaid -- as long as the mentally ill are being treated in the community and are not being sent into the criminal justice system.

The measure calls for pilot programs to be established in South Florida, the Tampa Bay region and the Pensacola area.

A similar bill is sponsored by Sen. Mike Fasano, R-New Port Richey, in the Senate.